Is 24-7 Home Care or Facility Care the Best Option?

By Jennifer Lagemann

Jane M. was in her bedroom heading out into the living room when I arrived at her house that day. Her walker couldn’t quite fit through the doorway, and she lifted the walker sideways to get it through and placed it down to continue walking.

I moved her couch a little bit to give her more space, but it still wasn’t enough. Weeks later, I got a call in the office and discovered that she had fallen and was on hospice care. She died a few weeks later.

Another client of mine was a recent widow, living in independent living, and needed one-to-one support on top of the support that her community provided. I brought her an iced coffee from Scooter’s one night, which completely changed her mood! But that moment wouldn’t have been possible without additional support from home care.

These aren’t extreme or anomalous situations. Loneliness is as toxic as smoking 15 cigarettes a day, according to researchers.

According to an analysis conducted by the Joint Center for Housing Studies of Harvard University, which looked at the 2019 American Housing Survey, “Less than half of adults who rely on a mobility aid such as a wheelchair or walker live in a home that has both a no-step entry or ramp and a bedroom and bathroom on the main level.”

This isn’t to say that decline is inevitable either, but it’s important to frequently re-evaluate an environment’s fitness across the lifespan.

So, it begs the question: Is home care or facility care the best option for your clients or their loved ones? The short answer: It depends. There are many benefits, costs and nuances that come with each setting. Here’s a closer look:


According to Genworth, the monthly median cost for a home health aide was $5,148 in 2021. That compares with $1,649 for adult day health care and $4,500 for assisted living. At a nursing home the cost is even steeper: $7,908 for a semi-private room and $9,034 for a private room.

Benefits of home care

  • Familiar, warm environment
  • Generally cheaper than a private nursing home room (until 11+ hours of daily care are needed). The Genworth study shows the median hourly cost in 2021 for a home health aide was $27 an hour and the daily cost for a private room at a nursing home is $9034/30 = $301. Divide that by $27 an hour and you get 11.15 hours of home health care to be equal to the private nursing home room. Of course, it is possible to get a live in that’s cheaper than $301 a day, but many agencies charge more than that now.
  • More control over choice of staff

Drawbacks of home care

  • Less socialization and community with peers
  • Planning and cost of home modifications needed
  • Lack of advanced medical care on site. However, it is possible to get a doctor, nurse and dentist to make house calls. Some elderly patients have had X-rays and teeth pulled at home.

Benefits of facility care

  • Maintenance-free living
  • Among peers
  • On-site amenities (which could include pools, massage, etc.)

Drawbacks of facility care

  • Less control over staff
  • Less opportunity for one-on-one relationship-building with caregiver
  • Visitation by family and outside caregivers may be restricted, as during the pandemic

There’s no right or wrong answer when making this decision, but it’s important to consider each person’s unique needs and how each environment stacks up.

Important questions

When I answered the phones in a home-care office, I can’t tell you how many times I got on a call with someone who didn’t know what kind of care their loved one needed. There’s nothing inherently wrong with that — it’s difficult to know, especially if the individual requiring care is no longer able to communicate clearly. Here are some good questions to share with client families so they can get the dialogue going before they start to Google facilities or care agencies.

Care-related needs
  • What types of activities and tasks are you able to complete independently?
  • Which activities and tasks do you need assistance with?
  • If you had assistance, how would you want your life to be different than it is now?

If a client or their loved one is unable to communicate, their family member should have a list of the activities and tasks they need help with, the medicines they take, and whether they have skilled-nursing needs. Skilled nurses can help with medication, wound care and other medical needs. Home-care agencies and facilities will also want to know if the individual has pets, allergies, and family members involved with or actively providing care.

Financial and administrative questions

Although the following questions are written for “you” (meaning your client), they can also be asked regarding your client’s loved one.

  • Are you a veteran? The U.S. Department of Veterans Affairs pays for in-home and facility care in some cases, but it can take a long time to get approval and there are also income requirements.
  • Do you have a long-term care insurance policy?
  • Do you have a healthcare proxy (to make medical decisions) and a power of attorney (to make financial decisions)?

A facility will also want to know the name of your client’s primary care doctor and medical specialists your client sees.

Some states and LTC policies allow family members to get paid as caregivers and some don’t. Facility care ranges from adult day centers to skilled nursing facilities. Some communities offer just one living arrangement (e.g., independent living or assisted living), while others offer a continuum of care.

The long-term care system is incredibly complex. Prepare your financial planning clients for the conversations they need to have when evaluating providers and finding living arrangements that best suit them or their loved ones.

Jennifer Lagemann is a home-care expert who has served as a family caregiver and administrator/care manager. She has held roles in franchise and independent companies and is the founder of NextJenn Copy, a marketing and strategy consulting firm for senior and caregiver-facing brands.


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